Medical A/R Billing Specialist

Statement of Purpose:  This position is accountable for all steps in the billing process including processing medical claim information through data-entry in the EMR, and researching and correcting data entry errors using eClinicalWorks. This position uses knowledge of CPT and ICD-10 codes to determine the appropriate order and combination of alpha, numeric or symbolic data to ensure accuracy in entering medical claim information. This position is in a primary care and behavioral health social service setting.

Sign on Bonus of $800 after 90 days of successful employment.

 Primary Tasks/Responsibilities:

• Process an average of 80 claims daily including follow up accounts.
• Review claims data to ensure the insurance sequence is correct for billing (primary, secondary, etc.)
• Submitting claims for services rendered to insurance companies in a timely fashion
• Verifying patients’ insurance coverage
• Working directly with the insurance company, the patient, and clinic staff to get claims processed and paid
• Ensuring patient demographics including name, date of birth, and insurance number are accurate on claims.
• Work closely with Third Party Liability (TPL), help patient’s update COBs.
• Know and understand CMS regulations for billing.
• Reviewing and appealing denied and unpaid claims to resolve denial instances
• Achieve maximum reimbursement for services rendered
• Monitoring and updating patient AR balances
• Scrubbing of claims, timely follow-up for missing required items.
• Tracking and updating the Aging Report, and working patient accounts for accuracy.
• Answering questions patients, providers and third party insurers may have about billing
• Reviewing patient bills for accuracy and completeness and obtain any missing information
• Handling collections and unpaid accounts by establishing payment arrangements with patients, monitoring payments, and following up with patients if or when there is a lapse in payment.
• Monitor and report billing error patterns.
• Cover Front Office locations as needed based on coverage needs.
• Sign In Answer Phone Queues and Emails for Billing.
• Assist patients with the Sliding Fee Discount Program.
• Perform other duties as assigned

 Education/Professional:

• Minimum of 2 years of experience as medical biller or denial specialist in primary care and behavioral health setting highly preferred.
• Experience working with multiple third party payers including Medicaid, Medicare, Managed Care, HMO/PPOs.

 Knowledge, Skills and Competencies Required:

• Strong knowledge of and able to easily navigate Medicaid, Medicare, HMOs, and private payer systems
• Knowledge of EMR systems, preferably with eClinicalWorks.
• Microsoft suite and data systems proficiency, including Electronic Medical Records.
• Ability to effectively communicate both written and verbally.
• Ability to effectively utilize problem-solving and decision-making techniques.
• Ability to make effective judgments and decisions based on objective criteria.
• Demonstrated ability to work effectively and professionally with individuals from varied background and experiences.
• Attentive to detail and strong organizational skills.
• High comfort working in a busy environment with changing priorities.